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Archives for April 2015

We have an abundance of accurate, relatively inexpensive tests for sexually transmitted infections (STIs) but the trick is engaging patients and health professionals so the proper tests are given to the right individuals.

In the edition of ASHA’s Sex+Health podcast we chat with J. Dennis Fortenberry, MD, MS, professor of pediatrics and medicine at Indiana University School of Medicine, about barriers to STI testing and what we can do to empower patients and providers alike.

When you think of HIV prevention, condoms are probably the first thing that comes to mind (which is great, because they should! Condoms are a proven method to reduce your risk for HIV and other sexually transmitted infections during intercourse.) But there is another option for those who may be at higher risk for HIV—pre-exposure prophylaxis, or PrEP.

PrEP involves taking a pill once daily to prevent HIV infection in someone who is HIV-negative. The pill—approved by the FDA as PrEP in 2012 and marketed under the brand name Truvada—contains a combination of two antiretroviral drugs that stop the virus from reproducing in the body. When taken consistently, every day, PrEP has been shown to reduce the risk of HIV infection in people who are at high risk by more than 90%.

So who is PrEP recommended for? The Centers for Disease Control and Prevention (CDC) offers these guidelines on people who should consider taking PrEP:

Anyone who is in an ongoing relationship with someone who is HIV-positive.

Gay or bisexual men who have had anal sex without a condom or have been diagnosed with an STI in the past 6 months.

Heterosexual men or women who do not regularly use condoms with partners with an unknown HIV status who are at substantial risk for HIV infections (e.g. people who inject drugs).

People who have injected illicit drugs in the past 6 months and have shared injection equipment or have been in treatment for injection drug use in the past 6 months.

While PrEP is recommended for different groups, it has received the most attention in the gay community. Gay and bisexual men are disproportionately affected by HIV: in 2013, they accounted for 81% estimated HIV diagnoses among all males aged 13 years and older and 65% of all persons receiving an HIV diagnosis that year. Given these alarming statistics, PrEP has been endorsed as an important prevention tool by a number of prominent activists and organizations, including the Human Rights Campaign, the Gay Men’s Health Crisis, AIDS United, and the World Health Organization.

However, PrEP has garnered some controversy as well. Among the criticisms is one that echoes the controversy that surrounds HPV vaccines—the assumption that PrEP will lead to risky sexual behavior and promote promiscuity. But as with HPV vaccination, research has shown that such fears are unfounded. A study of the multinational iPrEx study that first established the effectiveness of a daily dose of Truvada to prevent HIV found “no evidence of risk compensation that would offset the benefits of PrEP.” In other words, no evidence that taking PrEP led to risky sexual behavior. In fact, the reverse was true. As the study authors note, “Indeed, participation in the study was associated with safer sexual behavior.”

Another concern voiced is that PrEP will cause gay and bisexual men to abandon condoms, which have been a mainstay of HIV prevention efforts. But an analysis by CDC shows condom use on the decline before the approval of Truvada as PrEP in 2012. The CDC data indicate that in 2011, 57 percent of men who have sex with men reported having unprotected anal sex at least once in the previous 12 months, up from 48 percent in 2005. Given the decline in condom use, the availability of another prevention method should be welcomed.

But this not to suggest that PrEP replaces condoms. Far from it. Rather, PrEP offers a new option to those at high risk—another tool in the HIV prevention toolbox that fits alongside condoms, not as a replacement. After all, while PrEP helps prevent HIV infection, condoms offer protection against a host of other STIs as well.

Despite the promise offered by PrEP, it is necessarily the right choice for everyone. In addition to requiring taking a pill every day consistently, those on PrEP are also advised to see healthcare provider regularly for follow up and get tested for HIV every 3 months. But for those willing to take on the commitment, PrEP offers the promise of a highly effective way to prevent HIV.

If you’re interested in PrEP and want to find a PrEP provider near you, check out our website sayyestoprep.org.

It’s been associated with urethritis in men and linked to cervicitis and pelvic inflammatory disease in women. In one study of young men and women, it was found to be more common than gonorrhea infection. But odds are you’ve never been tested for, or even heard of, this sexually transmitted bacterial infection.

So what is it? Mycoplasma genitalium, or Mgen, was first identified in 1980. It is a bacterium that can infect the reproductive tract and is passed on through sexual contact. In men, infection with Mgen can cause urethritis (swelling and irritation of the urethra), and in women it has been linked to cervicitis (inflammation of the cervix), pelvic inflammatory disease, and possibly infertility.

How common is it?
While there aren’t statistics to show how common infection with Mgen is, in one study of 2,932 young men and women, Mgen was more prevalent that gonorrhea, but less than chlamydia and trichomoniasis. Like those infections, Mgen can be asymptomatic, particularly in women. Women may have pain with urination, vaginal discharge, or discomfort with sex, while men may experience burning, painful urination and sometimes a discharge from the penis.

How do you test for it?
There is no widely available commercial diagnostic test for Mgen. However, labs can use a specific type of test method—nucleic acid amplification testing (NAAT)—to identify an Mgen infection. Testing can be done on urine (men and women) or cervical swabs (women).

Can it be treated?
If someone is diagnosed, the infection can be easily treated. Since Mgen is a bacterial infection, it can be cured with antibiotics, typically with a single dose of azithromycin. Occasionally, additional antibiotic treatment is required.

VD is for everybody,
Not just for the few.
Anyone can share VD,
With someone nice as you.
VD is for everybody,
Darling have no doubts!
That anyone can get VD,
That’s what…its’ all…ABOUT!!

In the late 60s, ASHA launched a PSA V.D. is for Everybody. Complete with its own catchy tune (how ‘bout them lyrics?), the spot shows a cross-section of society to drive home the point that sexually transmitted infections (STIs, or venereal diseases as they known in the day) can affect anyone.

We should probably update that to say STIs affect almost everyone…

Each year in the U.S. there are 20 million new STIs. Add each year’s new cases to those that already exist and you’re looking at about 110 million current STIs in the country.

Also, consider that experts believe more than half of all sexually active individuals have at least one infection in their lifetime with the human papillomavirus (HPV). None of this is to be alarmist or scary—the vast majority of those HPV infections are harmless and go away on their own. This is just to highlight that STIs are very common and having one means very little apart from that one is very normal.

So talk to your healthcare provider about getting tested! We don’t test nearly enough for STIs: healthcare providers and patients alike often think STIs happen to other people. Despite the fact that these infections are common and we get them from doing stuff nature pretty much intended we do, there is still so much shame and stigma we often don’t take advantage of the health care we need and deserve.

Which STIs should you consider testing for?
There’s no one size fits all approach to STI testing, so this is why it’s so important to have a conversation with your doctor or nurse to see which tests you might need; it varies based on things such as your age, gender, and risk factors. Here’s some general guidance to jumpstart your thinking:

CDC recommends everyone ages 13-64 have at least one HIV test.

Sexually active women under age 26 should have a chlamydia test each year.

At age 21, women should begin cervical cancer screening with Pap tests. Most cervical cancers are caused by certain types of HPV that, in a few cases, don’t clear on their own. The good news is that cervical cancer can be prevented!

Routine testing for common STIs is recommended for men who have sex with men. This includes annual tests for HIV, and syphilis. Also chlamydia and gonorrhea tests to check for infections of the urethra and anus (for those who’ve had insertive and/or receptive anal sex), and a test of the throat for those who’ve performed oral sex in the last year (chlamydia rarely is transmitted by oral sex so there’s no testing recommendation there).

For a drill-down on STI tests, including how they’re done and more insights into which tests you might think about having, visit our Get Tested page. Remember your medical and sexual history go a long way towards determining which STI tests you need (and just how often you should be tested), so learn more about talking with your healthcare provider and get the conversation started.

In the spring, an old organization’s fancy lightly turns to thoughts of love. And sex. And sexual health. This spring, ASHA is launching a new campaign—Spring into Sexual Health—to bring greater awareness to this important subject. Over the next three months, we’ll be rolling out new content and highlighting three important national health observances: STI Awareness Month in April, National Women’s Health Week in June, and Men’s Health Month in June. Check back here all throughout spring and visit our Facebook and Twitter pages to see all that’s blooming this spring.

A new series of videos featuring two noted herpes experts, H. Hunter Handsfield, MD, and Kees Rietmeijer, MD, PhD, discussing essential facts about herpes. They explain the differences between the two virus types, who should get tested for herpes and the types of testing available, managing herpes during pregnancy, and strategies to prevent herpes infection.

Do you know what STI tests are right for you? Recommendations vary based on things such as your age, gender, and risk factors, so learn more.

It’s been associated with urethritis in men and linked to cervicitis and pelvic inflammatory disease in women. But odds are you’ve never been tested for, or even heard of, this STI. Find out what it is.

Listen to a podcast featuring adolescent sexual health expert J. Dennis Fortenberry, MD, speaking with ASHA’s Fred Wyand on the subject of STI testing. See more from Dr. Fortenberry on sexualhealthTV.org.

New in May:

A new video on the subject of sexual issues affecting postmenopausal women. Sexual difficulties can make a woman feel isolated and alone. The subject can be hard to talk about, even with a partner. Watch the video and learn about what women can do to address sexual problems.

In honor of STI Awareness Month, take a few minutes to find out how much you know sexually transmitted infections. This quick quiz will help you learn what you know, and what you need to learn, about STIs. Let us know how you did in the comments.